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Updated: Jul 14, 2025
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Prediction of refractory gastroesophageal reflux disease in young children
Songpon Getsuwan1, Pornthep Tanpowpong1, Napapat Butsriphum1
1Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
A new predictive model can identify children with refractory gastroesophageal reflux disease (GERD). This tool uses clinical features and MII-pH monitoring to aid in predicting GERD that doesn't respond to medication.
Area of Science:
- Pediatric Gastroenterology
- Medical Diagnostics
- Predictive Modeling
Background:
- Gastroesophageal reflux disease (GERD) affects many children, with some requiring invasive treatments for refractory cases.
- Lack of prognostic tools hinders early identification of children at risk for refractory GERD.
Purpose of the Study:
- To develop a predictive model for identifying refractory gastroesophageal reflux disease (GERD) in pediatric patients.
- To identify key clinical features and monitoring results associated with treatment-resistant GERD.
Main Methods:
- Retrospective review of pediatric GERD cases at a university hospital.
- Definition of refractory GERD as unresponsiveness to medication for over 8 weeks.
- Construction of a predictive model using clinical data and 24-hour multichannel intraluminal impedance-pH (MII-pH) monitoring.
Main Results:
- The study included 205 children; 21.5% were diagnosed with refractory GERD.
- Refractory GERD was significantly associated with motor disabilities, recurrent aspiration pneumonia, prematurity, and abnormal reflux episodes.
- The predictive model demonstrated an AUC of 76.8%, with 77.3% sensitivity and 64% specificity.
Conclusions:
- A predictive model integrating clinical features and MII-pH monitoring can aid in identifying young children with refractory GERD.
- This model offers a potential tool to guide treatment decisions for pediatric GERD.
Background:
Many children respond to medical treatment for gastroesophageal reflux disease (GERD). However, some may require invasive intervention for refractory disease. Due to the lack of prognostic tools in children, this study aimed to develop a predictive model for refractory GERD.
Methods:
A retrospective review was performed in children with symptoms of GERD at a university hospital. Refractory GERD was defined as an unresponsive disease after optimal treatment with medication for >8 weeks. The predictive model was constructed based on clinical features and 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring results.
Results:
A total of 205 children were included with a median (IQR) age of 0.6 (0.3, 2.0) years. Over half of the patients (59.5%) had motor disabilities. Forty-four children (21.5%) were diagnosed with refractory GERD and subsequently underwent fundoplication. Multivariable analysis suggested that the refractory disease was associated with motor disabilities (OR: 5.35; 95% CI: 2.06-13.91), recurrent aspiration pneumonia (OR: 2.78; 95% CI: 1.24-6.26), prematurity with an onset of GERD at a post-conceptual age <40 weeks (OR: 6.76; 95% CI: 1.96-23.33), and abnormal total reflux episodes according to age (OR: 2.78; 95% CI: 1.24-6.19), but not the acid exposure time or symptom association analysis. The predictive model for refractory GERD based on associated factors revealed an area under the ROC curve of 76.8% (95% CI: 69.2%-84.3%) with a sensitivity of 77.3% and a specificity of 64% when applying a cutoff score of ≥2.5.
Conclusions:
The predictive model, using clinical features and MII-pH, may be an additional tool to predict refractory GERD in young children.
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